Table 4.

Methodological limitations of included studies

	Methodological limitations	Authors (Year)
Finite element studies	- Potential bias in selection of models into analysis.	Lyu et al. (2022) [33] Elshazly et al. (2023) [34] Elshazly et al. (2024) [23] Elshazly et al. (2024) [35] Karsli et al. (2024) [36] Karsli et al. (2024) [37]
	- Lack of the simulations involving PDL and/or other teeth.	Elshazly et al. (2023) [34] Elshazly et al. (2024) [23] Elshazly et al. (2024) [35]
Laboratory studies	- Potential wear of models during testing. Forces from repeated aligner use can degrade surface integrity, affecting fit and force application and transmission. - Lack of PDL and saliva in settings.	Cowley et al. (2012) [22] Gao et al. (2017) [38] Brown et al. (2021) [39] Elshazly et al. (2022) [24] Takara et al. (2022) [41] Traversa et al. (2024) [40]